HOUSEHOLD INFORMATION (2011 CALENDAR YEAR)

OTHER FINANCIAL AID RESOURCES

5. Do you qualify for funding through the Charles B. Keesee Educational Fund, Inc.?

YesNo

6. Have you applied for funding through the Charles B. Keesee Educational Fund, Inc.?

YesNo

7. Will you receive funding through the Charles B. Keesee Educational Fund, Inc. for the 2012-2013 academic year?

YesNo

If yes, how much?

8. Do you qualify for VA Educational Benefits?

YesNo

9. If you qualify for VA Educational Benefits, what chapter?

10. If Chapter 33 (Post 9/11) will you qualify for 100% benefit?

YesNo

Please contact the Office of the Registrar at (704) 406.3591 for the Certificate of Eligibility.

11. Will you receive any additional scholarships or grants from sources other than the School of Divinity at Gardner-Webb University during the 2012-2013 academic year?* Please list sources and amounts.

*If the information about your outside scholarships changes after completing this application, please notify the Director of Admissions of the School of Divinity immediately.

INCOME INFORMATION (2011 CALENDAR YEAR)

11. Will student be eligible to file an IRS form 1040A, 1040EZ, or 1040TEL?

YesNo

12. Adjusted Gross Income
$Dollars.Cents

(IRS 1040-line 37, 1040 A-line 21, 1040 EZ-line 4)

13. Federal Tax Paid
$Dollars.Cents

(IRS 1040-line 55, 1040 A-line 35, 1040 EZ-line 11)

14. Income student earned from work
$Dollars.Cents

15. Income spouse earned from work
$Dollars.Cents

16. Untaxed Social Security and Welfare
$Dollars.Cents

(ADC/AFDC) Benefits

17. Deductible IRA and Keogh payments
$Dollars.Cents

18. Untaxed portions of pensions from IRS
$Dollars.Cents

(IRS 1040 lines 16a-16b or 1040A lines 12a-12b) Exclude rollovers

19. Interest on tax free bonds

20. Housing, food & living allowances for clergy, military
$Dollars.Cents

21. Child support received for all children
$Dollars.Cents

Yearly Amount

22. Child support paid due to divorce or separation
$Dollars.Cents

23. As of today, total balance of cash, checking and savings accounts
$Dollars.Cents